Sherry Merkur, Anna Maresso and David McDaid
The last decade has seen an increasing interest in some countries of the potential of using behavioural science to inform our understanding and influence policy design. The Eurohealth Observer section kicks off with a look at the fashionable area of applying the principles of behavioural science to nudge populations towards better health and wellbeing. It discusses the growth in popularity of these health nudges and questions the evidence base on their effectiveness and cost effectiveness. It goes on to suggest where these principles may have a role to play in enhancing elements of health promotion and public health policy.
The latest issue of Eurohealth (volume 20, issue 2), which has just been published by the European Observatory on Health Systems and Policies (in which LSE Health is a partner), looks at some recent developments in this area.
In an effort to set out the broad context on why health behaviours matter, Mackenbach discusses their role within the persistence and widening of health inequalities in modern welfare states. With observed disparities in smoking and alcohol consumption, the uptake of exercise and healthy diet linked to socio-economic status, it becomes apparent that tackling these risk factors with effective interventions could have an impact on the inequalities in population health status. Whether or not incentives to change health behaviours are desirable or ethical depends on a complex mix of factors. The article by Schmidt attempts to disentangle the salient issues by identifying four goals and ten key dimensions of incentive programmes. The tool kit provided is a first step to systematically analysing different types of incentives, and could supply the basis for comparing incentive programmes of similar design.
Prainsack and Buyx contribute to this debate by bringing in a unique perspective – that of solidarity. They argue that by focusing on what people have in common rather than what sets them apart, solidarity is particularly relevant and compatible with ‘nudging’ practices because it can foster sensitivity to social inequalities and safeguard against inappropriate stigmatisation of target groups. Providing us with a national perspective, ten Have and Willems discuss the current debate in the Netherlands on using incentives to influence lifestyle and promote better health, and whether or not health insurance premiums should be differentiated to take into account people’s unhealthy lifestyle choices.
In the Eurohealth International section, Greer and Lillvis look at the difficulties of establishing intersectoral governance for Health in All Policies. They go on to suggest potential solutions for how policy-makers can create good functioning and enduring intersectoral governance to promote public health strategies.
Both of the articles in the Eurohealth Systems and Policies section reflect reforms to address budgetary pressures posed by the recent difficult economic climate. Kwong and colleagues discuss additional challenges faced by the health care payers in Poland and Hungary and how they have been confronted through pharmaceutical cost containment strategies. They also present the potential for risk-sharing schemes for medicines in the face of financial and performance uncertainty. Voncina and Sagan report on the newly implemented joint hospital procurement programme in Croatia. They describe the details of this decentralised approach and reflect on success in terms of the quality and the cost of procured goods.
Eurohealth Monitor features a new book on health professional mobility, which presents practical tools and policy responses in a changing Europe. Also featured is a new book on regulating long-term care quality that provides country-specific case studies to highlight policy options. As usual, the News section brings you a selection of national and international developments in the health sector. We hope you enjoy the Summer Issue.